Provider Demographics
NPI:1093155921
Name:MOHAMMADI, TARANA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:TARANA
Middle Name:MARIE
Last Name:MOHAMMADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5839 W MAPLE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2278
Mailing Address - Country:US
Mailing Address - Phone:248-855-7500
Mailing Address - Fax:248-855-5627
Practice Address - Street 1:5839 W MAPLE RD STE 109
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2278
Practice Address - Country:US
Practice Address - Phone:248-855-7500
Practice Address - Fax:248-855-5627
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103613207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology